ATI RN Adult Medical-Surgical (NGN) – ATI Adult
Medical-Surgical Proctored Exam Study Guide, Original
NGN-Style Practice Questions & Answers, Comprehensive
Med-Surg Review, Cardiovascular, Respiratory,
Gastrointestinal & Hepatic, Renal & Genitourinary,
Endocrine & Metabolic, Neurological, Musculoskeletal,
Immune & Infectious Disorders, Perioperative Care,
Pharmacology, Laboratory Values, Prioritization, Patient
Safety & Clinical Judgment
Question 1: A nurse is caring for a client with diabetic ketoacidosis (DKA).
Which laboratory finding is most consistent with this diagnosis?
A. Serum pH of 7.38
B. Serum bicarbonate of 22 mEq/L
C. Serum glucose of 180 mg/dL
D. Serum potassium of 5.2 mEq/L
CORRECT ANSWER: D. Serum potassium of 5.2 mEq/L
Rationale: In DKA, acidosis causes a shift of potassium from the intracellular to the
extracellular space, leading to hyperkalemia despite total body potassium depletion. The
other values are within normal limits or not consistent with DKA.
Question 2: A client with heart failure is prescribed furosemide. Which
assessment finding indicates the medication is having the desired therapeutic
effect?
A. Decreased peripheral edema
B. Increased jugular venous distention
C. Weight gain of 2 kg in 24 hours
D. Crackles auscultated in lung bases
CORRECT ANSWER: A. Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload. A
decrease in peripheral edema indicates a reduction in extracellular fluid volume,
demonstrating the desired effect. The other options indicate worsening fluid overload.
Question 3: A nurse is providing teaching to a client with angina who is
prescribed sublingual nitroglycerin. Which statement by the client indicates a
need for further teaching?
A. "I will sit down before taking this medication."
B. "I can take up to three tablets at 5-minute intervals."
C. "I will keep the tablets in their original dark bottle."
D. "I will swallow the tablet with a full glass of water."
CORRECT ANSWER: D. "I will swallow the tablet with a full glass of water."
,Rationale: Sublingual nitroglycerin must be dissolved under the tongue for rapid
absorption; it should never be swallowed. The other statements are correct regarding
administration and storage.
Question 4: A client with chronic obstructive pulmonary disease (COPD) has
an arterial blood gas (ABG) result showing pH 7.32, PaCO2 58 mm Hg, and
HCO3- 30 mEq/L. The nurse interprets this as which of the following?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Uncompensated metabolic alkalosis
CORRECT ANSWER: C. Fully compensated respiratory acidosis
Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory cause), and HCO3-
is elevated (metabolic compensation). Since the pH is still below normal, it is fully
compensated respiratory acidosis.
Question 5: A nurse is caring for a client with a new ileostomy. Which food
item should the nurse recommend to prevent an obstruction?
A. Nuts
B. Popcorn
C. Cooked carrots
D. Raw celery
CORRECT ANSWER: C. Cooked carrots
Rationale: Cooked vegetables are soft and easily digestible, reducing the risk of
obstruction. Nuts, popcorn, and raw celery are high in fiber and can cause blockages in
a new ileostomy.
Question 6: A client is receiving a blood transfusion and develops chills, fever,
and flushing. What is the nurse's priority action?
A. Slow the infusion rate
B. Stop the transfusion immediately
C. Administer diphenhydramine
D. Obtain a urine specimen
CORRECT ANSWER: B. Stop the transfusion immediately
Rationale: These symptoms indicate a febrile non-hemolytic transfusion reaction. The
priority is to stop the transfusion to prevent further complications, then notify the
provider and maintain IV access with normal saline.
Question 7: A client with cirrhosis has a serum ammonia level of 85 mcg/dL.
Which dietary change should the nurse anticipate?
,A. Increase protein intake
B. Decrease protein intake
C. Increase sodium intake
D. Decrease carbohydrate intake
CORRECT ANSWER: B. Decrease protein intake
Rationale: Elevated ammonia levels in cirrhosis are due to the liver's inability to convert
ammonia to urea. A low-protein diet is prescribed to decrease ammonia production
from protein breakdown in the gut.
Question 8: A nurse is assessing a client with hypokalemia. Which finding is
most indicative of this electrolyte imbalance?
A. Hyperactive bowel sounds
B. Muscle weakness and fatigue
C. Increased deep tendon reflexes
D. Bradycardia
CORRECT ANSWER: B. Muscle weakness and fatigue
Rationale: Hypokalemia causes neuromuscular manifestations including muscle
weakness, fatigue, and cramps. Hyperactive bowel sounds and increased reflexes are
associated with hyperkalemia.
Question 9: A client with acute pancreatitis is prescribed nothing by mouth
(NPO). The nurse understands this intervention is primarily intended to:
A. Prevent aspiration
B. Decrease gastric acid secretion
C. Reduce pancreatic enzyme stimulation
D. Allow for bowel rest
CORRECT ANSWER: C. Reduce pancreatic enzyme stimulation
Rationale: The NPO status reduces the stimulation of the pancreas by gastric
secretions, thereby decreasing the release of pancreatic enzymes and allowing the
pancreas to rest and heal.
Question 10: A nurse is caring for a client with a pulmonary embolism. Which
finding requires immediate intervention?
A. Oxygen saturation of 92%
B. Respiratory rate of 22 breaths/min
C. Sudden onset of chest pain and hemoptysis
D. Heart rate of 98 beats/min
CORRECT ANSWER: C. Sudden onset of chest pain and hemoptysis
, Rationale: Sudden chest pain and hemoptysis are signs of a massive pulmonary
embolism, indicating possible pulmonary infarction and requiring immediate
intervention. The other findings are less critical.
Question 11: A client with chronic kidney disease has a potassium level of 6.1
mEq/L. Which medication should the nurse prepare to administer?
A. Furosemide
B. Sodium polystyrene sulfonate
C. Epoetin alfa
D. Calcium acetate
CORRECT ANSWER: B. Sodium polystyrene sulfonate
Rationale: Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange resin that
exchanges sodium for potassium in the GI tract, lowering serum potassium levels. This
is the appropriate treatment for hyperkalemia.
Question 12: A nurse is providing discharge teaching for a client with a new
diagnosis of heart failure. Which instruction is most important to include
regarding daily weights?
A. Weigh yourself before eating breakfast
B. Weigh yourself at the same time each day
C. Weigh yourself after taking diuretics
D. Weigh yourself with shoes on
CORRECT ANSWER: B. Weigh yourself at the same time each day
Rationale: Weighing at the same time each day, on the same scale, and with similar
clothing provides an accurate comparison to detect fluid retention early. A weight gain
of 2-3 lbs in a day or 5 lbs in a week should be reported.
Question 13: A client with peptic ulcer disease is prescribed omeprazole. The
nurse should teach the client to take this medication at what time?
A. With meals
B. Before meals
C. At bedtime
D. On an empty stomach
CORRECT ANSWER: D. On an empty stomach
Rationale: Omeprazole is a proton pump inhibitor that should be taken 30-60 minutes
before a meal to maximize its effect on the proton pump, which is most active during
meals.
Question 14: A nurse is assessing a client with an abdominal aortic aneurysm.
Which finding is most concerning?
Medical-Surgical Proctored Exam Study Guide, Original
NGN-Style Practice Questions & Answers, Comprehensive
Med-Surg Review, Cardiovascular, Respiratory,
Gastrointestinal & Hepatic, Renal & Genitourinary,
Endocrine & Metabolic, Neurological, Musculoskeletal,
Immune & Infectious Disorders, Perioperative Care,
Pharmacology, Laboratory Values, Prioritization, Patient
Safety & Clinical Judgment
Question 1: A nurse is caring for a client with diabetic ketoacidosis (DKA).
Which laboratory finding is most consistent with this diagnosis?
A. Serum pH of 7.38
B. Serum bicarbonate of 22 mEq/L
C. Serum glucose of 180 mg/dL
D. Serum potassium of 5.2 mEq/L
CORRECT ANSWER: D. Serum potassium of 5.2 mEq/L
Rationale: In DKA, acidosis causes a shift of potassium from the intracellular to the
extracellular space, leading to hyperkalemia despite total body potassium depletion. The
other values are within normal limits or not consistent with DKA.
Question 2: A client with heart failure is prescribed furosemide. Which
assessment finding indicates the medication is having the desired therapeutic
effect?
A. Decreased peripheral edema
B. Increased jugular venous distention
C. Weight gain of 2 kg in 24 hours
D. Crackles auscultated in lung bases
CORRECT ANSWER: A. Decreased peripheral edema
Rationale: Furosemide is a loop diuretic used to reduce fluid volume overload. A
decrease in peripheral edema indicates a reduction in extracellular fluid volume,
demonstrating the desired effect. The other options indicate worsening fluid overload.
Question 3: A nurse is providing teaching to a client with angina who is
prescribed sublingual nitroglycerin. Which statement by the client indicates a
need for further teaching?
A. "I will sit down before taking this medication."
B. "I can take up to three tablets at 5-minute intervals."
C. "I will keep the tablets in their original dark bottle."
D. "I will swallow the tablet with a full glass of water."
CORRECT ANSWER: D. "I will swallow the tablet with a full glass of water."
,Rationale: Sublingual nitroglycerin must be dissolved under the tongue for rapid
absorption; it should never be swallowed. The other statements are correct regarding
administration and storage.
Question 4: A client with chronic obstructive pulmonary disease (COPD) has
an arterial blood gas (ABG) result showing pH 7.32, PaCO2 58 mm Hg, and
HCO3- 30 mEq/L. The nurse interprets this as which of the following?
A. Uncompensated respiratory acidosis
B. Partially compensated respiratory acidosis
C. Fully compensated respiratory acidosis
D. Uncompensated metabolic alkalosis
CORRECT ANSWER: C. Fully compensated respiratory acidosis
Rationale: The pH is low (acidosis), PaCO2 is elevated (respiratory cause), and HCO3-
is elevated (metabolic compensation). Since the pH is still below normal, it is fully
compensated respiratory acidosis.
Question 5: A nurse is caring for a client with a new ileostomy. Which food
item should the nurse recommend to prevent an obstruction?
A. Nuts
B. Popcorn
C. Cooked carrots
D. Raw celery
CORRECT ANSWER: C. Cooked carrots
Rationale: Cooked vegetables are soft and easily digestible, reducing the risk of
obstruction. Nuts, popcorn, and raw celery are high in fiber and can cause blockages in
a new ileostomy.
Question 6: A client is receiving a blood transfusion and develops chills, fever,
and flushing. What is the nurse's priority action?
A. Slow the infusion rate
B. Stop the transfusion immediately
C. Administer diphenhydramine
D. Obtain a urine specimen
CORRECT ANSWER: B. Stop the transfusion immediately
Rationale: These symptoms indicate a febrile non-hemolytic transfusion reaction. The
priority is to stop the transfusion to prevent further complications, then notify the
provider and maintain IV access with normal saline.
Question 7: A client with cirrhosis has a serum ammonia level of 85 mcg/dL.
Which dietary change should the nurse anticipate?
,A. Increase protein intake
B. Decrease protein intake
C. Increase sodium intake
D. Decrease carbohydrate intake
CORRECT ANSWER: B. Decrease protein intake
Rationale: Elevated ammonia levels in cirrhosis are due to the liver's inability to convert
ammonia to urea. A low-protein diet is prescribed to decrease ammonia production
from protein breakdown in the gut.
Question 8: A nurse is assessing a client with hypokalemia. Which finding is
most indicative of this electrolyte imbalance?
A. Hyperactive bowel sounds
B. Muscle weakness and fatigue
C. Increased deep tendon reflexes
D. Bradycardia
CORRECT ANSWER: B. Muscle weakness and fatigue
Rationale: Hypokalemia causes neuromuscular manifestations including muscle
weakness, fatigue, and cramps. Hyperactive bowel sounds and increased reflexes are
associated with hyperkalemia.
Question 9: A client with acute pancreatitis is prescribed nothing by mouth
(NPO). The nurse understands this intervention is primarily intended to:
A. Prevent aspiration
B. Decrease gastric acid secretion
C. Reduce pancreatic enzyme stimulation
D. Allow for bowel rest
CORRECT ANSWER: C. Reduce pancreatic enzyme stimulation
Rationale: The NPO status reduces the stimulation of the pancreas by gastric
secretions, thereby decreasing the release of pancreatic enzymes and allowing the
pancreas to rest and heal.
Question 10: A nurse is caring for a client with a pulmonary embolism. Which
finding requires immediate intervention?
A. Oxygen saturation of 92%
B. Respiratory rate of 22 breaths/min
C. Sudden onset of chest pain and hemoptysis
D. Heart rate of 98 beats/min
CORRECT ANSWER: C. Sudden onset of chest pain and hemoptysis
, Rationale: Sudden chest pain and hemoptysis are signs of a massive pulmonary
embolism, indicating possible pulmonary infarction and requiring immediate
intervention. The other findings are less critical.
Question 11: A client with chronic kidney disease has a potassium level of 6.1
mEq/L. Which medication should the nurse prepare to administer?
A. Furosemide
B. Sodium polystyrene sulfonate
C. Epoetin alfa
D. Calcium acetate
CORRECT ANSWER: B. Sodium polystyrene sulfonate
Rationale: Sodium polystyrene sulfonate (Kayexalate) is a cation-exchange resin that
exchanges sodium for potassium in the GI tract, lowering serum potassium levels. This
is the appropriate treatment for hyperkalemia.
Question 12: A nurse is providing discharge teaching for a client with a new
diagnosis of heart failure. Which instruction is most important to include
regarding daily weights?
A. Weigh yourself before eating breakfast
B. Weigh yourself at the same time each day
C. Weigh yourself after taking diuretics
D. Weigh yourself with shoes on
CORRECT ANSWER: B. Weigh yourself at the same time each day
Rationale: Weighing at the same time each day, on the same scale, and with similar
clothing provides an accurate comparison to detect fluid retention early. A weight gain
of 2-3 lbs in a day or 5 lbs in a week should be reported.
Question 13: A client with peptic ulcer disease is prescribed omeprazole. The
nurse should teach the client to take this medication at what time?
A. With meals
B. Before meals
C. At bedtime
D. On an empty stomach
CORRECT ANSWER: D. On an empty stomach
Rationale: Omeprazole is a proton pump inhibitor that should be taken 30-60 minutes
before a meal to maximize its effect on the proton pump, which is most active during
meals.
Question 14: A nurse is assessing a client with an abdominal aortic aneurysm.
Which finding is most concerning?
